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DIAGNOSTIC IMAGING REQUISITION 2675 Concession Rd. Kemptville, ON K0G 1J0 Phone: 6132586133 Ext. 400 OR Fax: 6132584997 Fax all Requisitions. By appointment only. Day, Evening & Weekends are available
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How to fill out diagnostic imaging requisition please

01
Obtain a diagnostic imaging requisition form from your healthcare provider or institution.
02
Fill in the patient's personal information, including name, date of birth, and contact details.
03
Provide details about the referring physician, including their name and contact information.
04
Specify the type of imaging needed (e.g., X-ray, MRI, CT scan) in the designated area.
05
Include pertinent clinical history or symptoms that justify the need for imaging.
06
Indicate any specific instructions or additional tests if required.
07
Check for any allergies or contraindications relevant to the imaging procedure.
08
Sign and date the requisition form, ensuring that it is completed and accurate.

Who needs diagnostic imaging requisition please?

01
Patients experiencing unexplained symptoms or injuries that require further investigation.
02
Healthcare providers who need to make a diagnosis based on imaging results.
03
Individuals undergoing routine screenings as part of preventive healthcare.
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A diagnostic imaging requisition is a formal request made by a healthcare provider for specific imaging procedures to be performed on a patient, such as X-rays, MRIs, or CT scans.
Healthcare providers, such as physicians or specialists, who determine the need for imaging studies for their patients are required to file a diagnostic imaging requisition.
To fill out a diagnostic imaging requisition, the healthcare provider should include patient details, the specific imaging requested, the clinical indication for the imaging, and any relevant medical history.
The purpose of a diagnostic imaging requisition is to ensure that appropriate imaging studies are requested to aid in the diagnosis, treatment planning, and monitoring of a patient’s health condition.
The information that must be reported includes the patient's demographic details, the type of imaging required, the reason for the request, clinical history, and the provider’s information.
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